MSA Re-Review Process and Reporting Changes

On December 21, 2016, the Centers for Medicare and Medicaid Services (CMS) announced a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) “Re- Review” Process. Additionally, CMS has updated TPOC timelines and amounts for No Fault, Liability, and Workers' Compensation claims.

Sometime in 2017 CMS plans to communicate the process of “re-review” of previously approved Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) amounts. The revised process is expected to update its existing re-review process to address situations where CMS has provided an approved amount, but settlement has not occurred and the medical care that supported the approved amount has changed substantially. CMS also expects its updated process to address situations where certain states rely on Utilization Review Processes to justify proposed WCMSA amounts.